Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report :

EXECUTIVE SUMMARY

1) Summary of Decision Area:

1.1. This report will include an update on the implementation of the Hampshire Model workstreams, following Cabinet approval on 22 December 2008 for the model, as set out in the report of the Hampshire Commission of Inquiry `Getting Personal: a fair deal for better care and support'.

1.2. In addition it contains specific detail regarding the countywide roll out plan for Self Directed Support and seeks approval to proceed with the approach.

2) Issues Covered in Report:.

2.1. The Commission of Inquiry considered 10 research briefings, in five public and four private sessions. It received nearly two hundred submissions in order to make the recommendations set out in the final report. The incremental implementation of the model within available resources was accepted by Cabinet on 22 December 2008 (decision reference 458). This report therefore contains an update on how Adult Services plans to manage the implementation of the model and provides more detail on the Self Directed Support (SDS) countywide roll out.

2.2. Adult Services is developing detailed governance arrangements and planning to manage the incremental implementation of the Hampshire Model. The department will manage the change in six linked workstreams, all of which are currently being planned in more detail and required resources identified. These are the Universal Offer, Free Crisis Care, Self Directed Support, Carers Initiatives, User Led Initiatives and Market Development.

2.3. Following the success of an initial project offering Self Directed Support in Basingstoke, a proposed approach for countywide roll out of SDS is put forward for approval. The proposed approach covers a two year plan, including an initial period of training, development, financial modelling and process change (year 1) followed on successful completion of this by a phased geographical implementation around the county (year 2). This roll-out will be managed by a dedicated SDS programme board, which in turn will report into the Personalisation Board, overseeing the implementation of the full model.

3) Recommendations:

3.1. That approval for the proposed approach to countywide roll out of Self Directed Support is given. This being a two year plan, including an initial period of training, development and process change (year 1) followed on successful completion of this by a phased geographical implementation around the county (year 2).

MAIN REPORT

1) Contextual Information:

1.1 The concordat Putting People First: a shared vision and commitment to the transformation of Adult Social Care, published 10 December 2007, made manifest a commitment to transforming care services by 2011. Transformation involves moving to a more person-centred or `personalised' adult social care system which emphasises the individual's dignity, right to self-determination, choice, control and power over the support services they receive.

1.2 Recognising the need to respond to the personalisation agenda proactively, and wishing to identify ways of tackling the unfairness and unsustainability of the current system, the Leader of Hampshire County Council, Councillor Ken Thornber, set up the Commission of Inquiry into Personalisation and the future services for adults in need of support and care.

1.3 On 22 December 2008 the Cabinet received the report of the Commission and:

· noted the recommendations contained within the report of the Commission of Inquiry. The full report can be accessed on http://www3.hants.gov.uk/getting-personal.pdf.

· approved the Hampshire Model as set out in the Commission report and supported its planned incremental implementation within available resources from April 2009. The model is described in full as Appendix E on the above link.

1.4 Cabinet noted that the Hampshire Model builds on the current Self Directed Support Project. This report presents a roll out plan for the current project based in Basingstoke to be implemented around the County.

2) Key Issues:

2.1 Adult Services proposes to manage the change in six linked workstreams. These are the Universal Offer, Free Crisis Care, Self Directed Support, Carers Initiatives, User Led Initiatives and Market Development. Each will be overseen by an Assistant Director, and will report into a dedicated Personalisation Board, chaired by the Director of Adult Services.

2.2 Detailed planning and resource mapping is currently underway for each of these workstreams.

2.3 Self Directed Support has been successfully piloted in Basingstoke (pilot running since May 2008). The objectives of the pilot were to

· Pilot Self Directed Support in one district Adult Social Care office

· Develop a target operating model for the future of Adult Services in Hampshire.

2.4 An internal review was carried out of the pilot, interviewing staff, project team members and service users involved. The review concluded that the pilot had partially delivered on both objectives. Self Directed Support is up and running in the Basingstoke Area Office, but requires further work for the approach to be sustainable. Significant progress has been made on developing the target operating model for the County, but again, further work is required before this model is transferable. The lessons learned from this review have therefore been used to plan the proposed countywide roll out.

2.5 The main conclusions of the review were that:

· Service users involved in Phase 1 have found the experience positive, enabling and highly beneficial. Some have referred to the benefits as life-changing.

· Staff are very positive about Self Directed support - there is a widespread belief that this is the right future for services.

· The basic SDS `tool kit' is now in place for Hampshire. Whilst this requires more work to ensure success in a wider scale implementation, real outcomes are already being delivered - particularly for our service users, but also for our staff.

· Appropriate time is needed to plan, assess the impact of the change and allow for better communications with staff, service users, carers, providers and all other stakeholders.

· There are several major issues which need to be resolved at a strategic or county level, which hampered or prevented progress in Basingstoke. These can be summarised as changes or adaptations required in our current IT systems, charging policy, team processes and business models - for both internal and external market.

· It is planned to do more modelling using the Basingtoke pilot site to fully understand and predict the financial impact of SDS countywide. To date the RAS has performed consistently and within budget.

2.6 The roll out plan has been designed to address and resolve all of the main issues raised by the review. Learning from Basingstoke has proved that it is crucial for staff to be fully involved and engaged, with the appropriate systems in place to support them. The current processes were not designed to do this for self-directed support - and this must be changed in order to support both our staff and our service users in the new way of working. As such, more time is needed to make these changes and the plan has been developed to incorporate this.

2.7 The plan has been designed to cover two years. The first year will focus on staff and external training and development. Recognising the importance of risk management, specific training will be given to all appropriate staff during year 1 on positive risk management. The first stage will provide the wider context of personalisation, and an introduction to SDS. It will also deliver the required process change - across IT systems, finance processes, charging policy and team processes. Effectively, year 1 of the roll out prepares the ground for a smooth implementation.

2.8 On successful completion of the first stage, Year 2 (commencing January 2010) will begin with focused training for frontline staff on the mechanics of delivering SDS. This will be delivered locally, to maximise coverage and minimise disruption. Following three months of focussed training, the locations trained will `go live' for all new service users, and for those coming up to review.

2.9 Training and `go live' will be phased geographically, in order to dedicate sufficient resource to on-site training and support. It is likely that this will commence in the North (January - April 2010), followed by the South (April - July 2010) and then the West (June - October 2010). However, this will need to be confirmed following more detailed planning, and is therefore currently subject to change.

2.10 The proposed approach will allow the department to meet Department of Health targets for Self Directed Support.

3) Outline of Options:

3.1 The following options were considered when designing the Self Directed Support roll out:

a) No further roll out of Self Directed Support

b) Immediate roll out commencing with the next geographical location.

c) Phased roll out - initial period (year 1) for training and process change, as highlighted in the review. Second phase to include supported, on-site training for a phased geographical go live at 3 month intervals around the County.

d) `Big bang' approach - implement all training, then go live simultaneously around the County

4) Option Analysis / Comparison:

a) No further roll out - given the Council's commitment to the Hampshire Model, and the key role that offering Self Directed Support will play in this, this option is not considered viable.

b) Immediate roll out - the lessons from the review indicated a number of county level or strategic issues which require changing/amending for SDS processes to work smoothly. Given the experience in Basingstoke, it was felt that trying to solve these office by office would result in a piecemeal solution, and would in fact take significantly more time than the proposed two-phase approach (option c). This option is not recommended.

c) This approach will allow us to address the strategic/countywide issues consistently, whilst working with staff, service users, carers, providers, voluntary organisations and colleagues in Health to prepare for the introduction of SDS. By commencing the next `go live' in 2010, the groundwork will be in place and the roll out can be implemented more quickly. This option offered a shorter timeframe to completion than option b and meets timeframes set down by central government. This is the recommended option.

d) `Big bang' approach. Although this offers advantages in terms of minimising the impact of running dual systems - the risks posed by going for a simultaneous implementation outweigh these. A phased approach allows sufficient resource to be available and present to support go live. The risks posed by introducing a new system of working can be better contained. The model used for phasing the roll out the Contact Centre functions provides support for a phased approach, and so the `big bang' option is not recommended.

5) Conclusions:

5.1 Self directed support underpins the Hampshire Model. The successful pilot in Basingstoke has allowed for significant lessons to be learnt - and care has been taken to incorporate these into planning a countywide implementation. The proposed approach allows for these issues to be resolved, supports the staff, service users and partners involved and continues to place Hampshire at the forefront of transformation to a more person-centred or `personalised' adult social care system.

6) Recommendations:

Please see Executive Summary for recommendations.

CORPORATE OR LEGAL INFORMATION:

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

An overall Equalities impact assessment has been carried out. This highlights that the rollout of self directed support offers benefits across a wide range of groups in terms of increased transparency, choice and control. This includes older people, people with a physical disability and those with mental health issues. The assessment highlighted the need for individual workstreams to also carry out assessments to ensure that all current and potential service users are communicated with effectively. These assessments will be carried out as the detailed workstream plans are developed.

2. Impact on Crime and Disorder:

The County Council has a legal obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all the decisions it makes on the prevention of crime. The proposals in this report have no proven impact on the prevention of crime.

3. Climate Change:

a) How does what is being proposed impact on our carbon footprint / energy consumption?

No impact has been identified, however an increase in local purchasing due to personalisation may reduce carbon footprint through reduced travel.

b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

The approach to roll out has not considered the need to adapt to climate change in detail, however as the workstreams are developed this will be taken into account in detailed planning.